A Private Fee-for-Service (PFFS) plan must cover all Medicare Part A and B benefits; it can also offer Medicare drug coverage (Part D).
- Premiums: A PFFS plan may charge a monthly premium in addition to the monthly Medicare Part B premium. If the PFFS plan offers extra benefits that Medicare does not cover, such as routine vision or dental services, it may charge you a higher premium each month.
- Deductibles and co-pays: PFFS plans charge both a yearly deductible and copays/coinsurances every time you see your doctor or other healthcare provider. Your costs will typically be lower if you see network providers.
Before getting costly care from a doctor outside of the PFFS network, it is important that you or your provider ask for an advance organization determination before to make sure that the care is covered.
If a doctor outside of the plan’s network treats you in an emergency, the doctor can charge you no more than what a network provider could have charged you for in-network care or $65, whichever is less.
- Yearly Limit on out-of-pocket costs: All PFFS plans must have yearly limit on out-of-pocket Part A and B costs. The out-of-pocket limit can be high but may help protect you if you need a lot of health care or need expensive treatment. Out-of-pocket costs include deductibles, copays and coinsurances.